Brain protection during surgery for type I aortic dissection

5^th World Heart and Brain Conference

September 24-26, 2018 Abu Dhabi, UAE

Marco Piciche

San Bortolo Hospital, Italy

Posters & Accepted Abstracts: J Cardiovasc Dis Diagn

Abstract :

There is an endless debate over which cerebral perfusion method results in better brain protection and lower mortality during repair of type A acute aortic dissection. Three main methods of cerebral protection exist, Antegrade Cerebral Perfusion (ACP), retrograde Cerebral Perfusion (RCP) and Deep Hypothermic Circulatory Arrest (DHCA). Although cerebral perfusion seems, in general, to be important for minimizing mortality, the selected method of cerebral perfusion seems to be a less important predictor of death. This is even truer during shorter procedures when Circulatory Arrest Time (CAT) is less than 40 minutes. Furthermore, a short period of CAT allows performing the operation with hypothermic circulatory arrest alone. Although many authors report that a period of DHCA of 40 minutes is safe, it is advisable to remain within 30 minutes while performing the open aortic anastomosis. Some authors reported significantly higher mortality for patients repaired with DHCA (14.5%) compared to those repaired with RCP (3.4%), while others demonstrated higher operative mortality in patients repaired using DHCA alone (26%) compared to those who have ACP (13%) or RCP (16%). Overall, whatever the method of cerebral protection, if circulatory arrest time is greater than 60 min there is a two-fold increase in the risk of mortality. As far as postoperative stroke is concerned, it does not differ, generally, for patients who undergo surgery with DHCA, RCP or ACP and it is commonly agreed that the most important risk factors for stroke are circulatory arrest time over 40 minutes and prolonged CPB time. For this reason, a shorter procedure, i.e. limited to the replacement of the ascending aorta and the intimal tear, instead of radical resection of the entire dissected aorta including the root and arch vessels, gives better results in terms of neurological outcome, length of stay in the intensive care unit and survival.

Biography :

E-mail: marco.piciche@libero.it